| NPI | 1871129445 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VALERIE ALBERT Credentialing Manager 469-850-5760 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery |
| Enumeration Date | 2020-03-16 |
| Last Update Date | 2020-03-16 |